Stroke patients' views on stroke outcomes: death versus disability

Aims: To determine how elderly stroke patients perceive different stroke ou tcomes, including death, relative to each other and how these Views compare with those of age/sex-matched controls. Participants and setting: Twenty-eight elderly patients discharged from hos pital with an acute stroke causing hemiplegia. Twenty-eight age/sex-matched control patients from the same hospital who had never had a stroke or tran sient ischaemic attack. Methods: Patients and controls were asked to rank 11 clinical scenarios of potential stroke outcomes, from the most to the least desirable outcome. Results: There was a striking bimodal distribution for sudden painless deat h in both groups. Painless death was preferred to even a minor stroke disab ility in over one-third of elderly individuals, whilst 20% would prefer sev ere disability rather than painless death. Sixty-nine per cent of stroke pa tients and 82% of controls ranked death as preferable to severe disability. Stroke patients may be more tolerant of disability (compared to death) tha n their controls (39% patients and 61% controls preferred death to any disa bility, p = 0.11). Conclusions: Our results suggest that many elderly individuals would rather die than be alive and severely disabled, This may have important implicati ons for acute stroke treatments such as thrombolysis.